Tuesday, January 26, 2010

If you become disabled, one of the things the insurance carrier may demand is that you submit to an Independent Medical Exam, or IME. Most people assume that this examination is impartial because the word independent is used in the title. However, that could not be further from the truth. In fact, it would be a lot more accurate to call the exam an Insurance Medical Exam because it is done by, for, and to benefit the insurance company. Unfortunately, insurance carriers are not looking for an independent evaluation.

If you are disabled and told by your insurance carrier to go for an IME, you should worry because most IME's are conducted by a doctor or another medical professional who depends upon IME's for a significant amount of his or her income. The IME doctor knows that the insurance carrier has no real interest in finding you disabled. Unlike most people, the IME doctor knows that the goal of most insurance carriers is to find reasons to deny, deny, deny your claim - even though you may have paid them hefty premiums through the years, and even though you may have become disabled and are unable to perform your job. Most insurance carriers are in the business to make money, not to protect their customers and make good on disability claims. And, denying claims allows the insurance companies to make more money.

The IME Doctor's Vested InterestMost medical professionals who perform IME's for insurance carriers usually do so on a regular basis either in a direct relationship with the carrier or with a third-party IME service, and this gives them a vested interest in finding disabled claimants healthy and able-bodied - they consider it job security. These medical professionals seek to tell the insurance carriers (their customers) what the insurance carriers want to hear, i.e., that the patient is medically fine and not entitled to disability benefits. They know that if they perform an independent examination and find the claimant to be disabled, it will lead to less repeat business from the insurance carrier, or carriers. In the end, the IME doctor most often chooses to keep his or her customer happy by giving them what they want - a medical report which supports denying the claim.

What You Can Expect During An IMEGiven the IME doctor's biased agenda, it is not surprising that most of these exams are not medically very sound. It usually starts with a record review. Before you have even met the IME doctor, the insurance company already has combed through your medical records, typically cherry-picking which records to provide to the IME doctor for review. The records are frequently taken out of context to make it seem as if the claimant's medical condition isn't too bad, or that the medical evidence is contradictory or ambiguous. As a result, even if the IME doctor may be inclined towards impartiality, he or she only is provided with controlled information.

Another fairly common practice among some IME doctors is to look for "holes" in your medical record. Something as simple as an accidental omission on the part of your treating physician can result in an IME doctor deciding that your medical report does not support your disability claim.

The carrier then provides the IME doctor with specific written questions for him or her to answer. Even if the IME doctor didn't know what the insurance carrier was looking for, these questions provide the guidance he or she needs to come up with the report the insurance carrier wants.

When the exam finally occurs, it usually is quite superficial. Most IME's only last a few minutes - surprising given the length of the IME doctor's report and the extensive list of clinical testing the doctor supposedly performed. Straight leg, Tinel's sign . . . the IME report may contain a litany of physical exam tests which a layperson has never heard of and so would have no idea whether these tests were performed or not. If you're scheduled for an IME, do not expect to receive a thorough exam. One can ask the question: so how can a superficial Independent Medical Exam determine whether or not a claimant is disabled? In my opinion, it can't.

Many IME reports are provided to the insurance company or scheduling company in draft form for review. It is not uncommon for the IME doctor to change the report to cater to the request of the insurance company or its agent because they understand that the insurance carriers are looking for reasons to deny claims. In fact, even after the final report has been provided to the insurance carrier, the IME doctors often will provide the insurance carrier with an addendum to address any additional concern the carrier may have.

Other Potential Problems With IME'sAdded to this already unfair system is the fact that many of these IME professionals often have their own preconceptions and biases about the medical conditions the claimants have. Many IME doctors will dismiss - outright - debilitating illnesses and conditions such as chronic fatigue syndrome and fibromyalgia because these conditions are not easily detectible through CT-scans, MRI's, or other diagnostic testing. This is not surprising given the fact that most IME doctors perform a lot of IME's. Unlike a treating physician (your doctor) who tends to examine and treat a patient over an extended period of time, IME doctors essentially see only a snap shot of the claimant's medical condition. The most an IME doctor can do is comment on the claimant's condition on the one occasion that he or she performs the examination on behalf of the insurance carrier.

Unfortunately, many medical conditions only can be observed and diagnosed over long periods of time, over numerous clinical visits tracking the patient's complaints, symptoms and clinical test results. Given their limited clinical interaction with the claimants and their general bias, it is no surprise that most IME doctors tend not to believe claimants and disregard or ignore claimants' self-reported symptoms such as dizziness, headaches and numbness. In general, IME medical professionals are not working for you, and you have every right to distrust their diagnosis and/or prognosis. In most instances, they are working against you.

What Can You Do About This?You cannot refuse to go to an IME. If you do, there is a high probability that the insurance carrier will deny your claim or cancel your benefits. However, you can be prepared by retaining an attorney knowledgeable in disability law at the outset. Our firm, for example, counsels our clients before they go to their IME's. And, we send a registered nurse from our staff with them to the examinations. That serves two purposes: 1) it tends to relax our clients, and 2) it sends a message to the independent medical professional performing the exam that the client's law firm is paying attention.

In addition, our registered nurse is a seasoned medical professional who will observe and understand what goes on and what is said during the IME, then will provide our firm's attorneys with a comprehensive report. She will know whether or not the IME doctor performed the clinical tests he or she claimed to have performed.

When you're talking about a disability claim, unfortunately IME's are a fact of life. But that doesn't mean you have to feel like a victim. Contact DeHaan Busse LLP for a free case evaluation, assistance with your disability claim, and to arrange for our registered nurse to accompany you to your Independent (insurance) Medical Exam.

Very interesting article. As someone suffering with disabilities myself, one of the most daunting things about being diagnosed was trying to figure out how the loss of income would prevent me from keeping the lifestyle I had worked so hard to achieve. Disability Insurance for individuals is important to consider; while people always seem to remember insuring their homes and cars, they forget that if your health were to take a turn for the worse, your income would likely suffer. Though we don't know what life will throw at us next, we can be prepared for the unexpected by protecting our income!